What are the guidelines and documentation requirements for X-rays being performed in a podiatrist’s office?
X-rays are diagnostic tests and as such require additional specific information on the Medicare CMS-1500 claim form or the electronic equivalent. When the x-rays are performed in the podiatrist’s office, it is necessary to place an X in the NO Box in Field 11d of the claim form or the electronic equivalent. It is also necessary to include the podiatrist’s name and NPI in Field 17/17a of the claim form or the electronic equivalent.
General Guidelines for X-RAYS:
- Medicare does not pay for screening x-rays. Abnormal signs or symptoms or an established disease or injury is needed to provide the Medical Necessity for taking X-rays.
- Codes 73620 and 73630 are not payable together on the same foot, same date of service.
- Medicare will pay for yearly X-rays for stable conditions only if it is Medically Necessary.
- Most Medicare carriers will allow and reimburse for one post-operative X-ray study, unless there is medical necessity for more frequency.
- It is necessary to justify the need for a complete X-ray study versus a limited study.
- Comparison studies involving an unaffected extremity do not demonstrate medical necessity.
Most Common Podiatry Studies
- 73600 Ankle examination two views
- 73610 Ankle examination complete study, minimum of 3 views
- 73620 Foot examination two views
- 73630 Foot examination complete study, minimum 3 views
- 73650 Calcaneal examination minimum 2 views
- 73660 Toe(s) examination minimum 2 views
CPT codes 73630, 73630, 73650 and 73660 are not reimbursable in any combination if performed on the same foot on the same date of service.
Use the appropriate modifier, as applicable, for the above codes. An anatomical modifier used solely usually indicates the bill is for both professional and technical components (i.e. -26 professional, -TC technical).
When the CPT Manual is accessed, specifically the Radiology Section, it clearly states under Written Report(s) the following:
“A written report, (eg. handwritten or electronic) signed by the interpreting individual should be considered an integral part of a radiological procedure or interpretation.”
Appropriate Documentation for an X-ray Report
- State the actual views that were obtained.
- Document a general overview of the X-rays that were obtained. Certainly there are other identifiable issues present in addition to the diagnosis that you ordered the X-rays for.
- "Target the Diagnosis." Whenever X-rays are obtained, there is a diagnosis code that is used to not only justify obtaining the X-rays, but also to bill for those X-rays. Wouldn't it behoove you to make mention of that diagnosis in the X-ray report?
This is my opinion.
Michael G. Warshaw
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